Get Well Soon
Helping you make a speedy recovery after surgery to remove a cancer of the gullet or upper stomach
What to expect after the operation
You will have a wound around the side of your chest. Depending on the approach used, you may also have a wound on your abdomen and sometimes in the neck. These may be raised and swollen at first but should gradually settle. You may bathe and shower as normal, but avoid rubbing soap or shower gel directly onto your wound. Pat it dry with a soft towel. Do not pick any scabs that form as they are protecting the new tissue growing underneath.
If your surgeon has used stitches or clips, then the ward staff will arrange for a district nurse from your general practitioner (GP) practice to remove these for you. This is normally done at your home 7–10 days after the operation. If you have had a chest drain, the stitches from this will also be removed by the district nurse, but may be taken out at a different time.
Some wounds require a dressing as they can leak a little fluid. If this is the case the ward nurses will arrange for the district nurses to come and change this dressing.
You will experience some pain following your surgery, around the site of your scar and on the back and side of the chest, but also at the front of your chest. You may feel a tingling or burning sensation in the front of your chest or a feeling of numbness; this is perfectly normal in people recovering from any operation that involves opening the chest (each rib has a nerve running underneath from front to back and these nerves are affected to some extent every time the chest is opened). This sensation can also occur in patients having keyhole surgery in the chest. The discomfort can be managed easily with painkillers. You are unlikely to experience these symptoms until after you have been discharged, because while in hospital you will probably have pain relief delivered by an epidural. You will normally be given a week’s supply of pain relief to take home with you (this will be decided according to your specific needs in consultation with your surgeon) and you will be able to get further supplies from your GP.
It can take a few weeks for the pain to settle and you may have some pain for up to 3 months after your operation. If you are experiencing pain, it’s important that you take your prescribed analgesics to relieve the discomfort. This will make you more mobile and will reduce the risk of complications such as chest infection. When the pain settles you should wean yourself off the pain-relief medication. A small minority of patients, about 5%, can develop long-term pain in their wound, but there are methods available to treat this if it occurs.
It is important to do your breathing and coughing exercises after the operation; walking around the ward with help, as soon as the staff allow, is also very important. These simple things will speed your recovery and prevent complications after the operation.
Keep an eye on your posture following your operation. The physiotherapist will have shown you some arm and shoulder exercises and you should continue to do these for 6 weeks. If you don’t do your exercises you can become stooped or tilted to one side and this could lead to a frozen shoulder or back pain.
Normally after being discharged from hospital you should continue to eat soft foods. It may take some weeks before you can progress to a normal diet.
Your stomach will now be at least partly in the chest and usually will have a smaller capacity. This means you should eat little and often. You are unlikely to be able to manage a normal-sized meal although the amount you can eat may increase with time. It’s important that you chew your food well, so if you have trouble with your teeth (which may cause difficulty with chewing) arrange to see your dentist.
As the join between the stomach and the remaining gullet (oesophagus) heals, the scarring may cause the join to narrow. If this happens swallowing food may become more difficult and occasionally food could get stuck. If you feel this (or anything else) is becoming a problem, get in touch with your allocated contact or the surgeon’s secretary. Sometimes it may be necessary for you to have a repeat endoscopy to see if the join has narrowed. It’s relatively straightforward to stretch up the join at the same time. You will be given specific advice on diet if you need it.
After your operation, you may find that your appetite has reduced, although it should return as you recover. Eating little and often will help to ensure that you are getting all the nutrients you need, even if you don’t feel hungry. Make sure you drink plenty of fluids, but not just before a meal, as they will fill you up.
If you lost weight before your operation you should speak with your allocated contact or GP for advice on improving your appetite and diet. Initially, many patients will lose more weight after going home, but this will level out and you will begin to gain weight, although this may take a little time.
In the long term, it is advisable to ensure your weight remains within the recommended guidelines, but most patients who have had an oesophagectomy do not return to their original weight. This is normal and is probably because you have a smaller stomach capacity.
In the first few weeks after surgery you may experience a number of gastrointestinal symptoms, but most of these will settle down as your body adapts to its new way of working.
Dumping syndrome is a common problem. There are two types – early and late.
Early dumping occurs soon after eating. It happens because after the operation the contents of the stomach can be emptied rapidly into the small intestine. Over-filling of the stomach can cause this, although there are other reasons. Symptoms may include dizziness, cramping, nausea, vomiting, sweating, or feeling ‘flushed’ after eating. Diarrhoea may also follow. The symptoms can be alleviated by eating little and often, avoiding drinking with meals, or in some cases, varying the diet.
Late dumping occurs an hour or so after a meal. It is caused by excess secretion of insulin in response to the stomach contents in the small intestine. This can lower blood sugar, and as a result the patient feels weak, finds it difficult to concentrate, experiences sweating, shakiness, and a feeling of hunger. Patients who experience late dumping symptoms have found that taking a glucose tablet or another form of sugar as soon as the symptoms start is very helpful in offsetting the effects.
Diarrhoea and flatulence can also be problems, as can gastric reflux and feeling sick, but these can generally be resolved with medication or diet and will improve over time as you learn to manage them. The OPA website also offers lots of good practical advice in this area.
Your body is using a lot of energy to heal itself, so you’ll feel more tired than normal – sometimes it can come upon you suddenly, but don’t feel that it’s going to be that way forever. As your physical activity levels improve, you will start to feel less tired. In the first few weeks, however, try to go to bed each afternoon for a couple of hours’ sleep; this will really help.
If you feel upset or emotional in the days and weeks after your operation, don’t worry – this is a perfectly normal reaction that many people experience.